Abstract
Background
Data on contemporary real‐world outcomes of interventional revascularization in patients ≥ 75 y of age with ST elevation infarction (STEMI) are limited.
Methods
We analyzed all 504 consecutive patients who underwent angiography for acute STEMI between 1999 and 2005 at our center, and followed them up over one year. Outcomes in patients ≥ 75 y of age were compared with younger patients.
Results
Patients ≥ 75 y of age (n = 115) were majority females (55% versus 21%, p < 0.001), more cases of diabetes (42% versus 27%, p = 0.004), hypertension (78% versus 65%, p = 0.03) and a history of coronary events (25% versus 15%, p = 0.002). Younger patients were more often smokers (63% versus 30%, p < 0.001). After coronary angiography patients ≥ 75 y of age underwent less frequent intervention (PCI; 84% versus 93%, p = 0.01). However, if PCI was performed, technical success rates were similar to younger patients (84% versus 86%). The 30‐d mortality was 13% versus 6.4% (p = 0.03), but after successful PCI, the 30‐d mortality rate was not significantly higher in old patients (7.4% versus 3.9%, p = 0.23). Bleeding complications were very low in both age groups if the radial access route was chosen. Multivariate predictors of 30‐d mortality were cardiogenic shock/survived cardiac arrest, ejection fraction < 30%, conservative treatment or unsuccessful PCI (OR 3.01), renal insufficiency, diabetes, and age. One‐y mortality was higher in the elderly (24.3% versus 9.9%, p < 0.001). Among 30‐d‐survivors, only multivessel disease and age were multivariate predictors of 1‐y mortality.
Conclusion
Patients ≥ 75 y of age benefit from PCI in STEMI, and failed or unattempted PCI worsens prognosis in the old as well as in younger patients. Copyright © 2009 Wiley Periodicals, Inc.
Keywords: acute coronary syndrome, percutaneous intervention, acute cardiac care
Full Text
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References
- 1. Bugeja G, Kumar A, Banerjee AK: Exclusion of elderly people from clinical research: a descriptive study of published reports. BMJ 1997; 315: 1059. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2. Gurwitz JH, Col NF, Avorn J: The exclusion of the elderly and women from clinical trials in acute myocardial infarction. JAMA 1992; 268: 1417–1422. [PubMed] [Google Scholar]
- 3. Berger AK, Schulman KA, Gersh BJ, Pirzada S, Breall JA, et al.: Primary coronary angioplasty vs thrombolysis for the management of acute myocardial infarction in elderly patients. JAMA 1999; 282: 341–348. [DOI] [PubMed] [Google Scholar]
- 4. Antoniucci D, Valenti R, Santoro GM, Bolognese L, Moschi G, et al.: Systematic primary angioplasty in octogenarian and older patients. Am Heart J 1999; 138: 670–674. [DOI] [PubMed] [Google Scholar]
- 5. The Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO III) Investigators . A comparison of reteplase with alteplase for acute myocardial infarction. N Engl J Med 1997; 337: 1124–1130. [DOI] [PubMed] [Google Scholar]
- 6. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, et al.: A more accurate method to estimate glomerular filtration rate from serum creatinine: A new prediction equation. Ann Intern Med 1999; 130: 461–470. [DOI] [PubMed] [Google Scholar]
- 7. Sakai K, Nakagawa Y, Kimura T, Doi T, Yokoi H, et al.: Comparison of results of coronary angioplasty for acute myocardial infarction in patients ≥ 75 Y of age versus patients < 75 y of age. Am J Cardiol 2002; 89: 797–799. [DOI] [PubMed] [Google Scholar]
- 8. Mehta RH, O'Neill WW, Harjai KJ, Cox DA, Brodie BR, et al.: Prediction of one‐year mortality among 30‐d survivors after primary percutaneous coronary interventions. Am J Cardiol 2006; 97: 817–822. [DOI] [PubMed] [Google Scholar]
- 9. Grines CL, Cox DA, Stone GW, Garcia E, Mattos LA, et al.: Coronary angioplasty with or without stent implantation for acute myocardial infarction. Stent primary angioplasty in myocardial infarction study group. N Engl J Med 1999; 341: 1949–1956. [DOI] [PubMed] [Google Scholar]
- 10. Stone GW, Grines CL, Cox DA, Garcia E, Tcheng JE, et al.: Comparison of angioplasty with stenting, with and without abciximab, in acute myocardial infarction. The Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) Investigators. N Engl J Med 2002; 346: 957–966. [DOI] [PubMed] [Google Scholar]
- 11. Haase KK, Schiele R, Wagner S, Fischer F, Burczyk U, et al.: In‐hospital mortality of elderly patients with acute myocardial infarction; data from the MITRA (Maximal Individual Therapy in Acute Myocardial Infarction) registry. Clin Cardiol 2000; 23: 831–836. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12. Zeymer U, Gitt A, Winkler R, Zahn R, Jünger C, et al.: Mortality of patients who are older than 75 y after ST elevation myocardial infarction in clinical practice. Dtsch Med Wochenschr 2005; 130: 633–636. [DOI] [PubMed] [Google Scholar]
- 13. De Geare VS, Stone GW, Grines L, Brodie BR, Cox DA, et al.: Angiographic and clinical characteristics associated with increased in‐hospital mortality in elderly patients with acute myocardial infarction undergoing per‐cutaneous intervention (Pooled PAMI). Am J Cardiol 2000; 86: 30–34. [DOI] [PubMed] [Google Scholar]
- 14. Brodie BR, Stuckey TD, Muncy DB, Hansen CJ, Wall TC, et al.: Importance of time‐to‐reperfusion in patients with acute myocardial infarction with and without cardiogenic shock treated with primary percutaneous coronary intervention. Am Heart J 2003; 145: 708–715. [DOI] [PubMed] [Google Scholar]